Knee Deep in Holistic Alternatives

Story by

Eve Jacobs

Injuries to the knees are all too common—for the young and old alike. Like shoulders and hips, knees are complicated structures that bear the brunt of daily life, whether it’s simply walking or taking part in sports, and they are prone to break down. A compromised knee can lead to osteoarthritis and other chronic problems. Surgical procedures have vastly improved in the last 30 years, but they are expensive and can be accompanied by complications. At Rutgers, researchers are investigating the feasibility of alternative approaches to improving function and decreasing pain in people with knee osteoarthritis.

The Rub on Knee Pain

Susan Gould Fogerite (left), an associate professor at Rutgers School of Health Related Professions, and Gwen Mahon, the school's associate dean, are the principal investigators of a study to evaluate the benefits of full-body massage to alleviate the symptoms of knee pain.

Photography:

John Emerson

A study underway will evaluate the effects of massage in alleviating chronic knee pain.

Athletes, even young ones, who damage their knees are prone to chronic problems and osteoarthritis, which is the leading cause of pain and disability among the elderly. Drugs and joint replacements are not cure-alls. However, a more holistic solution may be around the bend. Rutgers School of Health Related Professions (SHRP), in collaboration with Duke Integrative Medicine and Yale–Griffin Prevention Research Center, is studying massage therapy as a means to alleviate symptoms of osteoarthritis, thanks to a four-year grant from the National Institutes of Health. “People have turned to complementary and alternative therapies for musculoskeletal pain for a long time, but there is a need for more research indicating that it works,” says Susan Gould Fogerite, an associate professor at SHRP who is the principal investigator at the Rutgers site, along with Gwen Mahon GSBS’07, the school’s associate dean.

The same group did a pilot study in 2006, funded by the Centers for Disease Control and Prevention, which showed that massage therapy decreased pain and increased flexibility. Im­provement was still evident two months after therapy was discontinued. In a 2009 study, they evaluated dosages and timing, concluding that a weekly 60-minute session provided optimal practical treatment.

The new study will evaluate 222 adults with osteoarthritis of the knee. Participants, monitored for a year, will be randomly placed in one of three groups and receive Swedish massage or light-touch bodywork of the entire body, not just the knee, once each week for at least two months. “Everything is connected, including the immune system,” says Gould Fogerite. “There is a standard massage protocol, but the therapist can go back to a body part, such as the lower back, for additional attention.”

“It’s not just about treating an episode of disease,” says Gould Fogerite. “Complementary and alternative medicine present a new model of prevention, healing, and wellness.”

A Platform for Recovery

Charles Gatt (left) and Michael Dunn are researchers in the Department of Orthopaedic Surgery at Rutgers Robert Wood Johnson Medical School who have devised a scaffolding that may help the knee regenerate a meniscus.

Photography:

John Emerson

A new procedure could repair a torn meniscus, stimulating the body to create a new one.

Michael Dunn and Charles Gatt, researchers in the Department of Orthopaedic Surgery at Rutgers Robert Wood Johnson Medical School (RWJMS), have developed a procedure to treat a common knee injury: a torn meniscus. The operation calls for removing the damaged meniscus, which is like cartilage and acts as the knee’s shock absorber, and then surgically implanting a scaffold that generates a new meniscus. “The fiber-reinforced scaffold mimics the structure of the native meniscus,” says Dunn, founding director of the RWJMS Orthopaedic Research Laboratory. “It has a collagen sponge with fibers woven into the pattern to maintain the mechanical integrity of the knee. These fibers degrade over time, giving way to natural tissue.”

According to Gatt RWJMS’89, a surgeon who has been implanting the device during preclinical studies, more than 800,000 procedures take place each year in the United States to remove all or part of a damaged meniscus, an operation that provides only temporary relief from the deterioration of the knee and can lead to osteo­arthritis. If successful, the new method could decrease the need for joint-replacement surgery, of which more than 700,000 take place annually in the nation, according to the Centers for Disease Control and Prevention.

Several years of encouraging preclinical studies led the two researchers and their team to form NovoPedics Inc. to develop and market their product and to find a partner to manufacture the scaffolding. Because military personnel are highly at risk for a meniscus injury, the Armed Forces Institute of Regenerative Medicine will provide $1,500,000 to support research. Foundation Venture Capital Group has committed up to $500,000 to develop and market the product, called Meniscofix.

“This is truly translational research—basic science that leads to developing a product,” says Dunn, who has spent 25 years investigating the use of biomaterials to reconstruct parts of the knee. “After more testing and then clinical trials, the Meniscofix implant may become a new way to treat miniscus injuries and prevent arthritis in thousands of patients every year.”